目的:经口内镜下肌切开术(POEM)的门失弛缓症患者的反流症状被认为是胃食管反流所致,目前的治疗主要集中在酸抑制上。然而,其他因素如非回流酸化引起的发酵或淤积可能起作用。这项研究旨在确定“真正的酸反流”患者实际上需要酸抑制和胃底折叠术。
方法:在这项前瞻性大型队列研究中,主要目的是评估接受POEM的贲门失弛缓症患者“真酸反流”的发生率和危险因素.正常和延迟清除率的酸反流定义为“真正的酸反流”,而其他模式在pH值描记的手动分析中被标记为“非回流酸化模式”。这些发现得到了症状问卷的证实,食管胃镜检查,食道测压,POEM手术后3个月定时钡食管造影。
结果:54例门失弛缓症患者,18-80岁[平均年龄41.1岁(12.8岁),男性占59.3%,90.7%的II型贲门失弛缓症]接受了POEM,导致平均Eckardt评分显着改善(6.7至1.6;p<0.05)。在自动分析中,“真正的酸回流”为29.6%,而64.8%。在42.7%的患者中,酸发酵是主要的酸化模式。在多变量逻辑回归分析中,年龄增加(或,1.12;95CI,1.02-1.27;p=0.04)和程序前积分松弛压力(IRP)(OR,1.13;95CI,1.04-1.30;p=0.02)与POEM后患者的“真酸反流”显着相关。
结论:手动检查pH值有助于识别POEM后门失弛缓症患者的“真酸反流”。术前IRP可以是确定处于这种结果风险的患者的预测因素。
The symptoms of reflux in achalasia patients undergoing peroral endoscopic myotomy (POEM) are believed to result from gastroesophageal reflux, and the current treatment primarily focuses on acid suppression. Nevertheless, other factors such as nonreflux
acidification caused by fermentation or stasis might play a role. This
study aimed to identify patients with \"true acid reflux\" who actually require acid suppression and fundoplication.
In this prospective large cohort
study, the primary objective was to assess the incidence and risk factors for true acid reflux in achalasia patients undergoing POEM. Acid reflux with normal and delayed clearance defined true acid reflux, whereas other patterns were labeled as nonreflux acidification patterns on manual analysis of pH tracings. These findings were corroborated with a symptom questionnaire, esophagogastroscopy, esophageal manometry, and timed barium esophagogram at 3 months after the POEM procedure.
Fifty-four achalasia patients aged 18 to 80 years (mean age, 41.1 ± 12.8 years; 59.3% men; 90.7% with type II achalasia) underwent POEM, which resulted in a significant mean Eckardt score improvement (6.7 to 1.6, P < .05). True acid reflux was noted in 29.6% of patients as compared with 64.8% on automated analysis. Acid fermentation was the predominant
acidification pattern seen in 42.7% of patients. On multivariable logistic regression analysis, increasing age (odds ratio, 1.12; 95% confidence interval, 1.02-1.27; P = .04) and preprocedural integrated relaxation pressure (IRP; odds ratio, 1.13; 95% confidence interval, 1.04-1.30; P = .02) were significantly associated with true acid reflux in patients after undergoing POEM.
A manual review of pH tracings helps to identify true acid reflux in patients with achalasia after undergoing POEM. Preprocedural IRP can be a predictive factor in determining patients at risk for this outcome. (Clinical
trial registration number: NCT04951739.).